Former Medicare administrators identify different priorities for reform

Three former top Medicare administrators offered their proposals for reform Wednesday. The panel spoke at the Kaiser Family Foundation offices in Washington, D.C.

All three speakers agreed that substantial Medicare reform is not imminent, saying there is no political will or public outcry for changing a popular program that is not in immediate fiscal jeopardy. They also agreed that provisions of the Affordable Care Act are steps in the right direction for containing costs. However, they differed on which Medicare reforms are most needed.

Bruce Vladeck, the top Medicare administrator under President Bill Clinton, said market-based purchasing should be pursued more vigorously. President George H.W. Bush appointee Gail Wilensky advocated for a premium support model involving competitive bidding and payments adjusted for beneficiary income and health status. Their remarks came just hours before CMS announced the second round of its competitive bidding program for Durable Medical Equipment and supplies.

Mark McClellan, CMS chief under President George W. Bush, thinks ACA provisions do not go far enough in slowing Medicare growth. The healthcare law will keep Medicare growth to about 3.9% annually through 2021, compared to 5% annual growth for private insurance, according to a report Kaiser released in conjunction with the panel discussion.

Drug substitutions saved the government $13 million last year, but more drug substitutions under Medicare Part B would have saved an additional $6 million, the Office of Inspector General for Health and Human Services concluded in a recent report to Congress.